Early and late outcomes in patients excluded from same-day home discharge after transradial stenting and maximal antiplatelet therapy.
BACKGROUND
To develop a safe practice of same-day discharge after percutaneous coronary intervention (PCI), it is important to identify early the patients who need to remain hospitalized and potentially require more careful follow-up. In the EASY trial, a large number of patients with acute coronary syndromes were enrolled prior to PCI to be randomized between same-day discharge or overnight hospitalization. Based on a few angiographic criteria, suboptimal results, or clinical complications, some patients were excluded from randomization after PCI.


OBJECTIVE
We report the early and late outcomes of those patients, and evaluate the use of simple criteria precluding same-day discharge.


RESULTS
The rate of major adverse cardiac events including death, myocardial infarction, and target vessel revascularization in patients excluded from randomization (n = 343) was significantly higher at 30 days (10.2% vs. 1.6%), 6 months (17.5% vs. 5.6%), and 12 months (24.5% vs. 9%) compared with randomized patients (n = 1,005; P < 0.0001). At 12 months, only transient vessel closure (HR 1.78, 95% CI 1.10-2.65, P = 0.023) and a residual dissection >or= grade B post-PCI (HR 1.53, 95% CI 1.11-2.05, P = 0.011) were independent predictive factors of adverse outcomes.


CONCLUSIONS
Criteria associated with angiographic suboptimal results or clinical complications are useful to identify patients ineligible for same-day discharge after PCI, regardless of the clinical presentation. Patients excluded from same-day discharge after PCI for safety concerns have worse early and late outcomes. Transient vessel closure and persisting moderate dissection after PCI remain independent predictors of late adverse outcomes after PCI with maximal antiplatelet therapy.
Bertrand
Olivier F
OF
Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, Quebec, Canada. olivier.bertrand@crhl.ulaval.ca
Rodés-Cabau
Josep
J
Larose
Eric
E
Proulx
Guy
G
Gleeton
Onil
O
Nguyen
Can Manh
CM
Nault
Isabelle
I
Roy
Louis
L
Poirier
Paul
P
Costerousse
Olivier
O
De Larochellière
Robert
R
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009551:Night Care; D010351:Patient Discharge; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017534:Radial Artery; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors